Pediatric Thermal Injury Sherpath

Parents of a 6-year-old comment that their son enjoys playing outside most of the day during summer break. They apply SPF 10 sunscreen in the morning, and provide beverages to maintain the child's hydration. Which information is important to include in teaching for these parents? Select all that apply. A. Sunscreen should be reapplied frequently. B. Avoid sun exposure between 1000 and 1500. C. Encourage the child to wear multiple layers of clothing. D. Juice and cola are acceptable for maintaining hydration. E. Sunscreen should be SPF 15 or higher and have UVA and UVB protection.

A. Sunscreen should be reapplied frequently. Parents should be told to reapply sunscreen frequently when their child is outside for an extended time. B. Avoid sun exposure between 1000 and 1500. The nurse should teach parents to keep children out of the sun between 1000 and 1500 during the summer months. E. Sunscreen should be SPF 15 or higher and have UVA and UVB protection. Parents should be encouraged to use sunscreen with SPF of at least 15 with UVA and UVB protection.

A patient with burns on the face and neck has an order to apply moist sterile gauze and silver sulfadiazine to all burns. Which action should the nurse take first? A. Question the order for Silvadene. B. Change the order to moist gauze. C. Apply bacitracin ointment to face as ordered. D. Apply Silvadene as ordered, but avoid the eyes.

A. Question the order for Silvadene. Silvadene cream is not typically used on facial burns. The nurse should question the order.

A patient who sustained an electrical injury from a toaster complains of pain 9/10 to the right arm. Lab results show pH of 7.2, HCO3 of 17, and PCO2 of 40. Normal saline is running at 125 mL/hr, IV pain medications are ordered for every four hours. Which action should the nurse take first? A. Administer oxygen via nasal cannula B. Administer IV pain medication as ordered C. Increase IV fluid rate to 250ml/hr as ordered D. Change IV fluids to Ringer's Lactate as ordered

D. Change IV fluids to Ringer's Lactate as ordered The patient's lab results indicate metabolic acidosis. The nurse should change the fluids to ringer's lactate because it has a higher concentration of electrolytes and will help correct the problem.

The nurse is assessing a child with full thickness burns to the left lower leg after the child fell onto a wood-burning stove. The estimated TBSA is 7%. How would the nurse describe the severity of the wound? A. Major B. Minor C. Severe D. Moderate, uncomplicated

D. Moderate, uncomplicated A full thickness burn of the left lower leg is less than 10% TBSA and is described as a moderate uncomplicated burn.

A 17-year-old girl has burns to the face and neck after a kitchen accident. The parents tell the nurse that the girl does not interact with friends or family, spends most of her time in her room, and avoids going to school. Which actions should the nurse take? Select all that apply. A. Assess for suicidal ideation. B. Consult with a child life specialist. C. Recommend home schooling through graduation. D. Encourage the patient to verbalize feelings about her appearance. E. Discuss ways to use cosmetics to minimize the perceived disfigurement.

A. Assess for suicidal ideation. If a 17-year-old is self-isolating after a burn injury, the nurse would assess for suicidal ideation. Incidence of suicide is high in adolescents. B. Consult with a child life specialist. If a 17-year-old is self-isolating after a burn injury, the nurse would consult a child life specialist to help the child explore their feelings. D. Encourage the patient to verbalize feelings about her appearance. If a 17-year-old is self-isolating after a burn injury, the nurse would encourage the patient to verbalize feelings about her appearance. E. Discuss ways to use cosmetics to minimize the perceived disfigurement. If a 17-year-old is self-isolating after a burn injury, the nurse would discuss ways to use cosmetics to minimize the perceived disfigurement.

The parent of a 3-year-old presents to the emergency department reporting that the child turned over a hot pot of soup on his face and chest. The nurse notes clothing is still in place and the child has redness and swelling around the mouth and neck. Which action should the nurse take first? A. Assess the child's airway for patency B. Initiate IV fluid resuscitation as ordered C. Administer IV pain medication as ordered D. Assess the severity of the face and chest burns

A. Assess the child's airway for patency Patients with facial burns and inhalation injury are at risk for respiratory compromise. The nurse should assess the child's airway first.

The nurse is caring for a child with minor partial thickness burns on the arm after grazing an iron. The nurse notes the area is red without blistering. Which action should the nurse take next? A. Assess the child's pain level B. Determine the mechanism of injury C. Apply antibiotic ointment as ordered D. Irrigate the wound with saline as ordered

A. Assess the child's pain level After assessing the wound condition, the nurse should conduct a full pain assessment.

The nurse is caring for a child with moderate burns to the lower extremities who complains of 10/10 pain during range of motion exercises. Pain medications are ordered by the provider and administered before exercises. Which actions should the nurse take next? Select all that apply. A. Continue with ROM exercises. B. Allow the child to perform active ROM exercises instead. C. Use guided imagery throughout the remainder of the session. D. Administer IV pain medication after ROM exercises are completed as ordered. E. Explain that ROM will be painful, but is important to maintain function of joints.

A. Continue with ROM exercises. If the child experiences pain during the ROM exercises, the nurse should continue with ROM exercises, minimizing the time spent manipulating the extremity. C.Use guided imagery throughout the remainder of the session. If the child experiences pain during the ROM exercises, the nurse can use distraction methods, such as guided imagery. E. Explain that ROM will be painful, but is important to maintain function of joints. If the child experiences pain during the ROM exercises, the nurse should explain that ROM is important to maintain function.

The nurse is caring for a child with burn injuries to the arm after sticking a fork into an electrical outlet. The nurse notes the arm is red, swollen, and peripheral pulses are diminished. Which additional assessment order should be obtained related to this type of injury? A. ECG B. Chest CT C. Serum albumin D. Serum glucose

A. ECG The nurse should obtain an order for an ECG on a child who was electrocuted after sticking a fork into an electrical outlet to determine if cardiac activity was altered.

A child who sustained an electrical burn reports shortness of breath and chest heaviness. The nurse notes diaphoresis, and pallor. Which additional assessment(s) are a priority for the nurse to obtain? Select all that apply. A. Heart rate B. Serum glucose C. Serum sodium level D. Abdominal ultrasound E. Obtain an order for an ECG

A. Heart rate When a child with electrical burns complains of shortness of breath and chest heaviness, the heart rate should be assessed along with a full cardiac assessment E. Obtain an order for an ECG When a child with electrical burns complains of shortness of breath and chest heaviness, an ECG is a priority because the electricity can disrupt the electrical activity of the heart.

The nurse is preparing to debride the burn wound of a patient with major burns to both legs. The wound bed is blackened and peripheral tissues are erythematous with fluid-filled vesicles noted on the outer edge of the wound. Which action would be appropriate for the nurse to take? A. Leave the blisters intact during debridement B. Apply cream to the blisters prior to treatment C. Administer pain medication one hour prior to treatment D. Remove all dressings using clean gloves and alcohol swabs to loosen dried bandages

A. Leave the blisters intact during debridement Typically blisters are left intact when debriding partial thickness burns.

A child recovering from major burns four weeks ago complains of nausea, vomiting, and epigastric pain that worsen with eating. The nurse notes tenderness on palpation and a positive gastric aspirate positive for blood. Which provider orders should the nurse anticipate? Select all that apply. A. NPO B. Endoscopy C. Hemoccult D. IV protonix E. Administer PO acetaminophen

A. NPO If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate making the patient NPO to prevent pain. B. Endoscopy If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate sending the patient for an endoscopy to determine if a stress ulcer is present. D. IV protonix If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate giving IV protonix to decrease the risk for worsening stress ulcer.

A child with full thickness burns on the anterior trunk, abdomen and thighs has begun IV fluid resuscitation at 150 mL/hr. Which assessment findings indicate this treatment has been effective?Select all that apply. A. Serum sodium 135 B. Child cries without tears C. Moist mucous membranes D. Urine output 40 mL in last 3 hours E. Good skin turgor over other body areas

A. Serum sodium 135 Serum sodium of 135 is normal and indicates fluid resuscitation has been effective. C. Moist mucous membranes Moist mucous membranes indicate good hydration status and suggest fluid resuscitation has been effective. E. Good skin turgor over other body areas Good skin turgor indicates good hydration status and suggests fluid resuscitation has been effective.

The nurse is caring for a child with minor burns to the arms and hands from scalding. The parents voice concern regarding managing the child's pain. Which information should be included in parent teaching? Select all that apply. A. Use distraction as a method of pain relief B. Warm compresses can be applied for pain C. Limit activity for one week after burn injury D. Give oral acetaminophen as needed, every four hours E. Wrap gauze tightly around burn after applying ointment

A. Use distraction as a method of pain relief The nurse should encourage parents to use nonpharmacologic methods of pain management when possible. D. Give oral acetaminophen as needed, every four hours The nurse should tell parents that oral analgesics can be administered to children with minor burns to treat discomfort.

A 9-year-old child with severe burns on the face, trunk, and abdomen is lethargic and pale 24 hours after the initial burn. The nurse notes edema in the extremities, heart rate 135, urine output 60 mL over the past four hours. Which actions should the nurse take? Select all that apply. A. Obtain chest x-ray as ordered B. Administer colloids as ordered C. Apply silvadene cream as ordered D. Administer pain medication as ordered E. Increase the rate of IV fluids as ordered

B. Administer colloids as ordered Pallor, tachycardia, decreased urine output and edema indicate poor organ perfusion and third spacing of fluid into the interstitial space. Colloids should be administered to help decrease cell permeability and force fluids back into the cell. E. ncrease the rate of IV fluids as ordered Pallor, tachycardia, decreased urine output and edema indicate poor organ perfusion and third spacing of fluid into the interstitial space. The IV fluid rate should be increased to help improve renal perfusion.

The nurse is conducting a teaching session for new parents. Which information should be included in the discussion regarding bath safety? Select all that apply. A. Fill the tub to within 3 inches from the top B. Keep water heater thermostat at 120-degrees C. Use a thermometer to measure water temperature D. Leave the child unattended for only 1 minute or less E. Use the palm of the hand to test the water temperature

B. Keep water heater thermostat at 120-degrees During a discussion on bath safety, the nurse should teach the parent to keep the water heater at 120-degrees. C. Use a thermometer to measure water temperature During a discussion on bath safety, the nurse should teach the parent to measure the water temperature.

The nurse is educating a group of new parents on child safety. One of the parents comments that they use SPF 15 sunscreen on their 4 month old whenever they leave the house. Which information is important to include in the nurse's response?Select all that apply. A. Avoid sun exposure between 1200 and 1600. B. Sunscreen is contraindicated in infants younger than 6 months. C. Children should avoid going in the water after sunscreen is applied. D. Hats and shirts should be removed to prevent rising body temperature. E. Keep the infant in a shaded area when outside for an extended period of time.

B. Sunscreen is contraindicated in infants younger than 6 months. The nurse should inform parents that sunscreen is contraindicated in infants younger than 6 months E. Keep the infant in a shaded area when outside for an extended period of time. The nurse should encourage parents to keep infants in a shaded area when outside for an extended period of time.

The nurse is educating parents of a child with sunburn on the upper back and shoulders. Which statement, made by the parents, indicates the need for further teaching? A. "I can expect itching as the area starts to heal." B. "Cool compresses are effective for pain relief." C. "My child needs to be on bedrest for 3-4 days." D. "I will apply lotion when the skin begins to peel."

C. "My child needs to be on bedrest for 3-4 days." When educating a parent about sunburn, the nurse knows further teaching is necessary if the parents say they will keep the child with minor burns on bed rest for 3-4 days.

Upon entering the room of a child with minor burns on the back and anterior trunk after a trip to the beach, the child complains of itching to the area. Which actions should the nurse take? Select all that apply. A. Begin wound debridement B. Apply warm compress to the area C. Administer PO Benadryl as ordered D. Encourage parents to apply lotion to the area E. Explain that itching is a sign of normal healing

C. Administer PO Benadryl as ordered The nurse should administer an antihistamine to a child with itching over a minor burn. D. Encourage parents to apply lotion to the area The nurse should encourage parents to apply lotion to the area of a minor burn that itches. E. Explain that itching is a sign of normal healing The nurse should teach parents that itching is a normal sign of healing for patients with minor burns.

The nurse is caring for an 8-year-old patient with second degree burns over 15% of the total body surface area (TBSA). On assessment, the nurse notes the following vital signs: HR 134, RR28, BP 82/48, Temp 97.4. Which action should the nurse take first? A. Give IV antibiotics as ordered B. Administer IV dopamine as ordered C. Initiate IV fluid resuscitation as ordered D. Administer IV pain medication as ordered

C. Initiate IV fluid resuscitation as ordered A child with second degree burns and tachycardia should have IV fluid resuscitation.

A child recovering from a moderate burn to the anterior trunk and abdomen has Hgb 12, Na 140, K 4.7, and serum albumin 2.8. Which action is most important for the nurse to take? A. Transfuse 1 unit PRBCs as ordered B. Give albumin intravenously as ordered C. Provide high-calorie, high-protein foods D. Administer 1 gram of Potassium chloride as ordered

C. Provide high-calorie, high-protein foods A serum albumin of 2.8 indicated malnutrition. Protein is necessary for wound healing. The nurse should offer a high-calorie, high-protein diet to promote healing.

The nurse is educating new parents on environmental safety concerns to make in the home. A new mother states that she uses the microwave to heat the infant's bottles because it is convenient and quick. Which response by the nurse is most appropriate? A. "Place ice cubes in the bottle to decrease the temperature." B. "It is alright to give the baby a bottle right out of the refrigerator." C. "Breastfeeding is the best method of feeding and has no risk for injury." D. "The microwave heats unevenly and can cause scalding injuries to the mouth and throat."

D. "The microwave heats unevenly and can cause scalding injuries to the mouth and throat." The nurse should inform the patient that the microwave can lead to scalding injury.

The parent of a 7-year-old with deep partial thickness burns on the legs from a camping accident asks the nurse about the healing time for the child's injury. Which response by the nurse is most appropriate? A. "With proper care, the wound should heal in the next 1-3 weeks." B. "The wound will not heal without skin grafting and other surgeries." C. "You can expect the wound to heal in the next 3-7 days without treatment." D. "You can expect it to take 30 days to several months for complete healing."

D. "You can expect it to take 30 days to several months for complete healing." A deep partial thickness burn will heal in 30 days as long as it does not become infected.

During the assessment of a 16-year-old boy struck by lightning, the nurse notes urine output of 56 mL/hr. Urine appears tea-colored. Which action is most important for the nurse to take? A. Advance patient to regular diet as ordered B. Administer normal saline at 25 mL/hr ordered C. Insert an indwelling urinary catheter as ordered D. Administer Ringer's lactate at 150 mL/hr as ordered

D. Administer Ringer's lactate at 150 mL/hr as ordered Diminished urinary output and tea colored urine indicate myoglobinuria and renal compromise. Ringer's lactate should be administered for fluid resuscitation.

A nurse is conducting a home visit for a 4-year-old patient. Upon inspection, the nurse notes smoke detectors in the home, covered electrical outlets and a wood burning stove in the living area. Which action should the nurse take first? A. Ask parents whether there is a fireplace in the home. B. Question parents about the use of gas versus electrical cooking stove. C. Refer the parents to the social worker for assistance obtaining central heating. D. Determine whether or not the wood burning stove is easily accessible to the child.

D. Determine whether or not the wood burning stove is easily accessible to the child. The nurse should determine accessibility of the wood stove to the child to establish the risk or burn injury.

The nurse is caring for a child who has burns on the arms from touching a hot grill one hour ago. The nurse notes destruction of the epidermis and dermis, fluid-filled vesicles, and redness. The child reports pain 10/10. How would the nurse describe this burn? A. Major burn B. Full thickness burn C. Deep partial thickness burn D. Superficial partial thickness

D. Superficial partial thickness Destruction of the epidermis and dermis, fluid-filled vesicles, redness, and severe pain are indicative of a superficial partial thickness burn.

What is the extent of injury for a 1-year-old with burns to the posterior trunk, buttocks, and bilateral thighs? A. 9% B. 13% C. 29% D. 42%

C. 29% The extent of injury for a 1-year-old with burns to the posterior trunk, buttocks, and bilateral thighs is 29% according to the Lund and Browder chart.

A 5-year-old child has burns on the upper and lower arm, anterior trunk, and both hands. The calculated TBSA is ________%.

23.5

The nurse is caring for a child with circumferential burns to the abdomen. On assessment, the nurse notes tachycardia, tachypnea, and diminished bowel sounds. Which additional questions should the nurse ask? Select all that apply. A. "Have you expelled any gas?" B. "How did you get this burn?" C. "Are you experiencing any pain?" D. "Will your family come visit today?" E. "When was your last bowel movement?"

A. "Have you expelled any gas?" Circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea indicate abdominal compartment syndrome. The nurse should ask the patient about other GI activity such as expulsion of gas. C. "Are you experiencing any pain?" The nurse would conduct a thorough pain assessment on a patient with circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea. E. "When was your last bowel movement?" Circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea indicate abdominal compartment syndrome. The nurse should ask the patient about other GI activity such as bowel elimination patterns.

The parent of a 2-year-old calls the pediatric clinic reporting that the child touched a hot grill and has burns on the right forearm. Which additional information is most important for the nurse to gather? Select all that apply. A. Determine if the burn has blistered B. Ask about the temperature of the grill C. Determine what was cooking on the grill D. Ask if the child is complaining of severe pain E. Ask where the parents were at the time of the injury

A. Determine if the burn has blistered When a parent reports that their 2-year-old touched a hot grill, the nurse should ask about the condition of the wound to determine severity. D. Ask if the child is complaining of severe pain When a parent reports that their 2-year-old touched a hot grill, the nurse will assess the child's pain level, since this will always be a priority in caring for children.

A 5-year-old with severe burns weighs 25 kg. The child has a urine output 30 mL in the last two hours, serum sodium of 122, and serum potassium of 5.1. Which action is most important for the nurse to take? A. Administer IV fluids as ordered B. Assess serum glucose as ordered C. Administer Kayexalate PO as ordered D. Assess serum calcium level as ordered

A. Administer IV fluids as ordered The child with 30 mL of urine output in two hours, hyponatremia, and hyperkalemia has a fluid and electrolyte imbalance that should be treated with IV fluids.

A child with electrical burns from touching an active power line reports numbness in the fingers. The nurse notes the hands and arms are edematous. Which actions should the nurse take? Select all that apply. A. Assess capillary refill B. Assess the peripheral pulses C. Perform neurovascular checks D. Assess the toes and lower extremity E. Administer pain medication as ordered

A. Assess capillary refill When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should assess the capillary refill. B. Assess the peripheral pulses When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should assess the peripheral pulses. C. Perform neurovascular checks When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should perform neurovascular checks

A 12-year-old child has burns to the face, hands, legs, and palms after a house fire. Which action by the nurse is most important? A. Determine the TBSA B. Assess the airway for patency C. Begin IV fluid bolus as ordered D. Administer pain medication as ordered

B. Assess the airway for patency The priority nursing action is to assess the airway for all patients with facial burns

The nurse is discussing home safety with a group of new parents. One new father states, "We have placed electrical outlet covers on all the outlets in the baby's room." Which response by the nurse is most appropriate? A. "Tuck electrical wires behind large furniture." B. "All cleaning supplies should be placed under the sink in a cabinet, also." C. "Be sure to bring the child into the house during thunderstorms." D. "Any electrical outlets in the home that are within the child's reach should also be covered."

D. "Any electrical outlets in the home that are within the child's reach should also be covered." The nurse should educate new parents to cover all outlets in the home because the child will spend time outside their room.

The mother of a 5-year-old patient with major burns to the arm is concerned because the sterile dressing has adhered to the wound bed and cannot be removed without severe pain to the child. Which information should be included in the nurse's response to the mother? Select all that apply. A. The pain will subside within a week of injury. B. Antibiotic therapy will help relieve the child's pain. C. Nonpharmacologic methods will be effective to relieve pain. D. Moisten dressing with tepid water or sterile saline prior to removal. E. Administer pain meds 20-30 minutes prior to dressing change as ordered.

D. Moisten dressing with tepid water or sterile saline prior to removal. Dressings often adhere to the wounds as ointments and drainage dry over time. E. Administer pain meds 20-30 minutes prior to dressing change as ordered. To decrease pain, the nurse should encourage parents to give pain medication 20-30 minutes before dressing changes and follow-up appointments.